腹腔镜袖状胃切除术治疗代谢综合征50例疗效分析(两年随访)

Laparoscopic sleeve gastrectomy for metabolic syndrome: an analysis of 50 cases with 2-year followedup

目的探讨腹腔镜袖状胃切除术(LSG)治疗代谢综合征的安全性和有效性。方法回顾性分析2013年2月至2017年6月在解放军第一五三中心医院接受腹腔镜袖状胃切除手术的50例患者临床资料,记录并比较术前及术后1个月、3个月、6个月、1年、2年的体质量、体质量指数(BMI)、平均动脉压、血清甘油三脂、高密度脂蛋白、空腹血糖(FPG)、糖化血红蛋白(HbA1c)及糖尿病、高血压、高脂血症、睡眠呼吸暂停综合征、脂肪肝、关节退行性变改善情况。结果 50例患者均顺利完成LSG,手术时间(70.7±26.3) min,术后住院时间(7.0±1.7) d。所有患者术后随访时间均超过2年,无围手术期死亡及术后严重并发症发生,体质量、BMI在术后3个月可观察到明显下降(P<0.05);24例合并高血压,平均动脉压在术后1个月出现明显下降然后保持相对稳定(P<0.05),术后两年内高血压完全缓解率63%;35例合并高甘油三脂血症,血清甘油三酯在术后6个月出现明显下降(P<0.05),而高密度脂蛋白在术后1年出现有统计学意义的升高(P<0.05);32例合并糖尿病,FPG在术后1个月出现明显下降(P<0.05),HbA1c同样在术后1个月出现明显下降(P<0.05),其中12例完全治愈而且不需进行药物治疗,治愈率为37.5%。术后2年内患者脂肪肝、睡眠呼吸暂停及关节退行性变也得到不同程度的改善。结论 LSG治疗肥胖症安全性好、效果显著,在明显减轻体重的同时还能治愈或显著改善其合并的代谢综合征。

Objective To estimate the effect and safety of laparoscopic sleeve gastrectomy for metabolic syndrome.Methods Clinical data of 50 patients accepting laparoscopic sleeve gastrectomy were analyzed retrospectively.Body mass,body mass index(BMI),mean arterial pressure,serum triglyceride,high density lipoproteins,fasting plasma glucose,glycosylated hemoglobin A1c and obesity co-related diseases were recorded and compared preoperatively and 2 years after operation.Results LSG were successfully completed in all patients,the mean operation time was(70.7±26.3)min,postoperative hospitalization time was(7.0±1.7)d.All patients were followed up for more than 2 years without perioperative mortality and postoperative severe complications.Three months after operation,body mass and BMI decreased signifi cantly(P<0.05).In the 24 patients with hypertension,the average arterial pressure decreased signifi cantly 1 months after operation and remained relatively stable thereafter(P<0.05).Among them,15 patients returned to normal blood pressure in 2 years after operation,without oral antihypertensive drugs,the complete remission rate was 63%.In the 35 patients with hypertriglyceridemia,serum triglyceride decreased significantly 6 months after operation(P<0.05),while high density lipoprotein increased statistically 1 year after operation(P<0.05).In the 32 patients with type 2 diabetes,fasting plasma glucose decreased signifi cantly 1 months after operation(P<0.05),and the same to glycosylated hemoglobin A1c(P<0.05).Among them,12 patients were completely cured without drug treatment and the cure rate was 37.5%.Obesity-related diseases such as fatty liver,sleep apnea and joints degeneration,also improved in 2 years after operation.Conclusions LSG is eff ective and safe in the treatment of obesity.It can signifi cantly reduce body weight,and cure or signifi cantly improve related metabolic syndrome at the same time.